Tierney, OxyContin, and Limbaugh

(1) Persecuting doctors for treating pain patients, or pain patients for seeking adequate pain relief, is a bad thing. But (2) the diversion of potent opioids to the illicit markets is a real problem, with awful human and social consequences. John Tierney insists on (1), but wants to deny (2). Is Tierney (sub silentio) standing up for poor, persecuted Rush Limbaugh?

John Tierney’s Wednesday column this week on a Florida pain patient sent to prison for 25 years for prescription forgery was a chilling and well-told story about collateral damage in the War on Drugs and the weird injustices that can grow out of the culture of plea-bargaining.

According to Tierney, Paey was simply trying to get adequate pain relief, and got whipsawed by his doctors, the cops, and finally by the prosecutor, who insisted on the 25-year mandatory minimum sentence when Paey refused to plead guilty, went to trial, and was convicted. Tierney’s account is broadly consistent with contemporary press reports, though there might well be a side to the story we haven’t heard.

But Tierney’s Saturday column reads like a press release from Purdue Pharma, the maker of OxyContin, or perhaps from Rush Limbaugh’s defense lawyer.

(As Tierney somehow managed not to mention either time, the Paey case was, aside from the possibility that Paey was innocent and the fact that Limbaugh is rich and influential, precisely the same as Limbaugh case: that is, if you leave out the fact that Limbaugh violated the Federal money-laundering laws while he was at it.)

Tierney writes as if the only issue around the abuse of prescription opioids is iatrogenic addiction: i.e., patients getting “hooked” on the stuff their doctors prescribe. He’s right to say that iatrogenic addiction to the opioids isn’t a top-tier drug problem: not nearly as common or as hard to deal with, as, for example, iatrogenic dependency on the benzodiazepine tranquilizers such as Xanax.

But Tierney just dances past the real problem, which is the leakage of pills into the illicit market from both genuine patients, from scam artists who go from doctor to doctor getting scripts for imaginary ailments, and from a few frankly crooked doctors, and the drug abuse problems that result.

Ten percent of American high school seniors report having used one of the prescription opioids non-medically. The number of people reporting having started to use opioids non-medically in the past year has increased by a factor of five over the past decade, to 2.5 million per year, which puts it up there with cannabis and way above any other category of illicit drug use. (Figures from Table 5.3 of the National Survey on Drug Use and Health.)

The appearance of OxyContin, which was a pure form of oxycodone (the active agent in Percodan and Percocet) triggered a wave of opioid addiction in rural areas where heroin had never been a problem. Tierney quotes some of Purdue Pharma’s favorite statistical mumbo-jumbo to suggest that the problem was mostly “hype,” but that’s not the way it looked on the ground. Pure oxycodone is about as potent, milligram for milligram, as heroin, and generates a comparably hard-to-kick addiction in some users. At the height of the Oxy craze, Maine had more residents per capita in treatment for opiate dependency than did New York.

Tierney even hints that the DEA agents who are making cases against doctors are doing so out of cowardice, because the docs, unlike cocaine dealers, don’t fight back. This is outrageous, and Tierney ought to apologize.

I’ve had more than my share of disagreements with DEA as an organization, but DEA agents are brave, literally to a fault. Anyone who has ever worked with DEA knows that the usual problem is recklessness, not cowardice. DEA agents are more likely to be adrenaline-dependent than pusillanimous, and consequently tend to prefer cases that involve “dynamic entry” raids to the duller but sometimes more important cases that have to be made with bank records.

All in all, Tierney’s column constitutes one of the week’s shabbier pieces of journalism. I say that despite agreeing with Tierney that the current pressure on doctors is interfering with appropriate pain treatment and that some of what DEA is doing is causing more harm that it prevents.

But the combination of Tierney’s sloppiness with the facts, his willingness to accuse a bunch of the bravest people in the world of cowardice, and his curious omission of the Limbaugh case makes me wonder, just a little bit: are we being set up for Jeb’s pardon of Rush? As far as I can tell, a pardon is the only thing that’s going to keep the wingnuts’ favorite rabble-rouser out of a prison cell.

Footnote: I have sent a link to this post, with what I hope was a polite and restrained note, to Tierney, with an offer to publish verbatim any response he wants to make.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com